Follow the steps to successfully complete the referral form.

1. Press the ‘Get Form’ button to acquire the referral form and open it in your preferred editing tool.
2. Begin by entering the recipient's name as well as the date at the top of the form. This ensures the referral is addressed properly.
3. Fill in the patient's address and contact phone number to facilitate communication. It is crucial that this information is accurate.
4. Enter the patient's Medicare number and date of birth (DOB) to verify their identity and health coverage.
5. Provide the reason for the referral or diagnosis. Be detailed and include any relevant medical information, such as pathology, x-ray, and CT scan reports to help prioritize the case.
6. Indicate the referral period and describe any pain or numbness by marking on the provided diagram. This is vital for assessing the urgency of the referral.
7. Assess pain levels by completing the pain assessment sections for leg pain, arm pain, back pain, or neck pain. Use the given scale from 0 to 10 to quantify the severity.
8. Detail the patient's past medical history and list any current medications, especially those that could affect bleeding, such as Aspirin, , or .
9. Complete the referring doctor’s information, including their provider number and signature, to confirm the referral.
10. Determine the method of submission. If faxing, use the number provided on the form: 8374 4928. If mailing, send it to the Clinic C/D or the Department of Neurosurgery at Flinders Medical Centre, Bedford Park, SA 5042.
11. Finally, review all entered data for accuracy before saving changes, downloading, printing, or sharing the completed form.

Get started on completing your referral form online today for efficient medical processing.